A pain desk day: intrathecal pumps, phantom limbs, and the ibuprofen question settled less than you would like

The edition in brief

An electronic health record cohort of 38,433 adults having elective below-knee amputation between 2016 and 2025 found phantom limb syndrome coded within 12 months in 18.8% of those who received a perioperative peripheral nerve block against 15.1% of those who did not (Mantel-Haenszel relative risk 1.24, 95% CI 1.20-1.28, adjusted for age, sex and race only); length of stay was shorter with blocks, and the authors describe the association as exploratory and likely to reflect confounding by indication and differential surveillance. In 222 patients with advanced cancer starting intrathecal drug delivery at one academic centre, 91% discontinued systemic opioids, and joint longitudinal-survival models accounting for death showed Brief Pain Inventory severity falling by 0.014 units a day and interference by 0.020 units a day over the first 90 days, with symptom trajectories worsening before implantation and improving after. In 215 patients with chronic non-cancer pain followed a mean of 80 months, the intrathecal device explant rate was 26.1%, with device-related infection the leading cause at 9.3% of patients, and loss of analgesic efficacy accounting for only 5.6%. A three-arm randomised pilot in 30 adults with chronic neuropathic pain found combining ketamine infusions with 16 weeks of cognitive behavioural therapy and mindfulness feasible and safe, with 87% completing follow-up and exploratory pain outcomes improving in all arms. And a meta-analysis of eight randomised trials in 1,325 children found ibuprofen only marginally ahead of paracetamol for acute mild-to-moderate pain (standardised mean difference -0.28, 95% CI -0.57 to 0.00, P=0.052), at low certainty.